Format

Send to

Choose Destination
Eur J Surg Oncol. 2020 Feb;46(2):272-276. doi: 10.1016/j.ejso.2019.10.039. Epub 2019 Nov 2.

First Eastern European experience of isolated limb infusion for in-transit metastatic melanoma confined to the limb: Is it still an effective treatment option in the modern era?

Author information

1
North Estonian Medical Centre Foundation, Tallinn, Estonia; Tallinn University of Technology, Tallinn, Estonia. Electronic address: jyrite@gmail.com.
2
Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
3
Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia.
4
North Estonian Medical Centre Foundation, Tallinn, Estonia; Tallinn University of Technology, Tallinn, Estonia.
5
Tallinn University of Technology, Tallinn, Estonia; IVEX Lab, Tallinn, Estonia.
6
Tartu University Clinic, Tartu, Estonia.
7
North Estonian Medical Centre Foundation, Tallinn, Estonia.
8
Tallinn University of Technology, Tallinn, Estonia.

Abstract

BACKGROUND:

Isolated limb infusion (ILI) with cytotoxic agents is a simple and effective treatment option for patients with melanoma in-transit metastases (ITMs) confined to an extremity. Data for ILIs performed in Europe are sparse and to date no Eastern European ILI experience has been reported. The aim of the current study was to evaluate the efficacy of ILI in Estonia.

PATIENTS AND METHODS:

Data for twenty-one patients were collected and analysed. All patients had melanoma ITMs and underwent an ILI between January 2012 and May 2018. The cytotoxic drug combination of melphalan and actinomycin-D was used. Drug circulation times were 20-30 min under mildly hyperthermic conditions (38-39 °C). Primary outcome measures were treatment response and overall survival.

RESULTS:

Nineteen lower limb and two upper limb ILIs were performed. The female to male ratio was 18:3. The overall response rate (complete + partial response) was 76% (n = 16), with a complete response in 38% (n = 8). The overall long-term limb salvage rate was 90% (n = 19). During follow-up, eight patients (38%) died, two due to metastatic melanoma. Five-year overall survival was 57%.

CONCLUSION:

This first Eastern European report of ILI for melanoma ITMs shows results comparable to those from other parts of the world. In this era of effective targeted and immune therapies, ILI remains a useful treatment option, with a high overall response rate and durable responses in patients with melanoma ITMs confined to a limb.

KEYWORDS:

Actinomycin-D; Intra-arterial infusion; Isolated limb infusion; Melanoma loco-regional treatment; Melphalan; Metastatic melanoma

PMID:
31748147
DOI:
10.1016/j.ejso.2019.10.039

Conflict of interest statement

Declaration of competing interest None.

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center